Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2016
Unrepaired Tetralogy of Fallot-related Pathophysiologic Changes Reduce Systemic Clearance of Etomidate in Children.
Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characterize the PK of etomidate and explore the effects of TOF. ⋯ A decreased systemic clearance for etomidate in children with TOF resulted in a lower required infusion rate and variation with time to achieve the same plasma concentration and maintain an equivalent target concentration or have longer sedation and recovery times after bolus or continuous infusion than normal children.
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Anesthesia and analgesia · Sep 2016
Observational StudyThe Use of Standard Gastrointestinal Endoscopic Ultrasound to Assess Cardiac Anatomy.
In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist. ⋯ Given that the EUS images were not directly compared with TEE in these patients, we cannot comment definitively on the quality of these assessments and further studies would need to be performed to make a formal comparison. Based on this study, EUS technology can consistently assess the mitral valve, aortic valve, aorta, pericardium, and left ventricular function. Given its limitations, EUS technology, although not a substitute for formal echocardiography, could be a helpful early diagnostic tool in an emergency setting.
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Anesthesia and analgesia · Sep 2016
Lidocaine Impairs Proliferative and Biosynthetic Functions of Aged Human Dermal Fibroblasts.
The aged are at increased risk of postoperative wound healing complications. Because local anesthetics are infiltrated commonly into the dermis of surgical wounds, we sought to determine whether local anesthetics adversely affect proliferative and biosynthetic functions of dermal fibroblasts. We also evaluated the effect of local anesthetics on insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1), growth factors that are important regulators of wound healing. ⋯ Our results show that lidocaine inhibits processes relevant to dermal repair in aged HFB. The detrimental responses to lidocaine are due, in part, to interactions with IGF-1 and TGF-β1.
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Anesthesia and analgesia · Sep 2016
Practice and Outcomes of the Perioperative Surgical Home in a California Integrated Delivery System.
In this article, we report on the implementation and impact of a Perioperative Surgical Home (PSH) model for the total knee arthroplasty at an integrated delivery system (Kaiser Permanente). ⋯ Introduction of the PSH into an integrated delivery system resulted in a simultaneous reduction of LOS and SNF admission for total knee arthroplasty patients.
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Anesthesia and analgesia · Sep 2016
The Patterns of Utilization of Interscalene Nerve Blocks for Total Shoulder Arthroplasty.
The interscalene block (ISB) is a common adjunct to general anesthesia for total shoulder arthroplasty (TSA). The aim of the study was to report the current national demographics of the patients who are receiving ISB for TSAs. We performed a retrospective analysis of data from the National Anesthesia Clinical Outcomes Registry from 2010 to 2015. ⋯ From 2010 to 2014, there has been an increase in ISB utilization for this surgery (odds ratio, 1.21; 95% confidence interval, 1.19-1.23; P < .0001). Furthermore, we report a geographic distribution of block utilization in the United States. We have identified national patterns for the utilization of regional anesthesia for TSAs that may provide insight into future design of research studies.